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. 2016 Aug;44(3):246-58.
doi: 10.1111/apt.13677. Epub 2016 May 30.

Effects of disturbed sleep on gastrointestinal and somatic pain symptoms in irritable bowel syndrome

A Patel  1 , S Hasak  1 , B Cassell  1 , M A Ciorba  1 , E E Vivio  1 , M Kumar  1 , C Prakash Gyawali  1 , G S Sayuk  1   2   3
Affiliations

Effects of disturbed sleep on gastrointestinal and somatic pain symptoms in irritable bowel syndrome

A Patel et al. Aliment Pharmacol Ther. 2016 Aug.

Abstract

Background: Sleep disturbances are common, and perhaps are even more prevalent in irritable bowel syndrome (IBS).

Aims: To determine the effect of measured sleep on IBS symptoms the following day, IBS-specific quality of life (IBS-QOL) and non-GI pain symptoms.

Methods: IBS patients' sleep patterns were compared to healthy individuals via wrist-mounted actigraphy over 7 days. Daily bowel pain logs (severity, distress; 10-point Likert) stool pattern (Bristol scale) and supporting symptoms (e.g. bloating, urgency; 5-point Likert) were kept. Validated measures, including the GI Symptom Rating Scale-IBS, Visceral Sensitivity Index, Pittsburgh Sleep Quality Index and the IBS-Quality of Life were collected. Mediation analysis explored the relationship between sleep, mood and bowel symptoms.

Results: Fifty subjects (38.6 ± 1.0 years old, 44 female; 24 IBS and 26 healthy controls) completed sleep monitoring. IBS patients slept more hours per day (7.7 ± 0.2 vs. 7.1 ± 0.1, P = 0.008), but felt less well-rested. IBS patients demonstrated more waking episodes during sleep (waking episodes; 12.1 vs. 9.3, P < 0.001). Waking episodes predicted worse abdominal pain (P ≤ 0.01) and GI distress (P < 0.001), but not bowel pattern or accessory IBS symptoms (P > 0.3 for each). Waking episodes negatively correlated with general- and IBS-specific QOL in IBS (r = -0.58 and -0.52, P < 0.001 for each). Disturbed sleep effects on abdominal pain were partially explained by mood as an intermediate.

Conclusions: Sleep disturbances are more common in irritable bowel syndrome, and correlate with IBS-related pain, distress and poorer irritable bowel syndrome-related quality of life. Disturbed sleep effects extend beyond the bowel, leading to worse mood and greater somatic pain in patients with the irritable bowel syndrome.

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Conflict of interest statement

None of the authors have any conflicts of interest to report. No writing assistance was obtained.

Figures

Figure 1
Figure 1. Example of sleep actigraphy from a study subject
Actigraph tracing from a 7-day study period (time along x-axis), and measured activity (y-axis) Sleeping hours (red) are magnified to show detail, with waking episodes during sleep (red arrows) are recorded via patterned movement. Sleep episode duration (purple interval) is defined by the time between waking episodes.
Figure 2
Figure 2
Subjective etiologies of sleep disturbances by study group.
Figure 3
Figure 3. Actigraphy parameters by study group
Actigraphy parameters of particular interest included mean sleep episode duration (hours) waking episodes during sleep, longest undisturbed sleep episode (hours) and total hours of sleep per day.
Figure 4
Figure 4. Correlation matrix between GI symptoms and actigraphy, subjective sleep report in IBS patients
Correlations are color coded as indicated by the legend, with positive correlations shown in red, and negative correlations in blue. The color intensity reflects the strength of the correlation. GSRS = Gastrointestinal Symptom Rating Scale.
Figure 5
Figure 5. Correlation matrix between non-GI symptoms, quality of life, psychatric symptoms and actigraphy, subjective sleep report in IBS patients
Correlations are color coded as indicated by the legend, with positive correlations shown in red, and negative correlations in blue. The color intensity reflects the strength of the correlation.
See this image and copyright information in PMC

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